Nursing Research on the Green

2016 Abstract

Background: Obstetrical nursing care of pregnant women who have substance abuse issues and addictions can be complicated and fragmented. Since 2011, a regional health care system has been providing specialized care through the Obstetrics & Gynecology Department and the Addiction Services of the Behavioral Health Department for pregnant women who have substance abuse issues. An existing data base of approximately 150 patients was previously established, and included demographic and medical encounter information.

Significance: Obstetrical nursing care of pregnant women who have substance abuse issues and addictions can be complicated and fragmented. More information is needed to identify concepts and variables, through an extensive literature review, that can be evaluated for clinical contribution, and for utilization in follow-up evidence-based and research projects. This study identified factors that contribute to sobriety and healthy parenting one year beyond postpartum, thus expanding the current data base to support outcome-focused clinical management and future research opportunities. Results of this study may contribute toward more effective nursing interventions and interdisciplinary clinical management.

Purpose/objective: This study explored current clinical practice within a Midwestern health care system to compare with current related published literature about prenatal, perinatal, and postnatal care among women with substance abuse issues. The study objectives were to expand the current data base to support best practice for outcomes of sustained sobriety and healthy parenting, as well as to provide opportunities for continued research.

Methods/project: IRB oversight was obtained. The sample included pregnant women, aged 18 or older, who were abusing substances and delivered their babies between 1/1/2012 and 6/30/2014. A two-method approach with comparative descriptive analyses was used. A preliminary literature review with quality analyses (e.g., type/level of evidence; intervention effectiveness) informed the study by identifying concepts and related practice applications that contribute to, or interfere with, sustained postpartum sobriety and healthy parenting. A retrospective electronic health record (EHR) review was conducted simultaneously with an updated systematic review of literature. The retrospective EHR review used an established data base of approximately 150 women who received prenatal, perinatal, and postpartum care within a combined obstetrical and behavioral health practice. Concepts evaluated were: demographic characteristics, health history, child custody, depression, intimate partner violence, home environment, homelessness, inadequate clinical care, incarceration, parental stress, potential for child abuse, psychological status, and substance abuse. Identified concepts from the literature review were compared with similar concepts selected from the EHR at three time points. All data were entered in an Excel file and statistically analyzed using SASS. Comparative data and statistical analyses were conducted and included descriptive statistics (range, means, medians, standard deviations); tables and a conceptual map were developed to illustrate findings.

Results: N=51 pregnant women, 54 pregnancies (multiple births), 55 babies (1 twin delivery). All women reported some type of adverse childhood event which informed the development of an integrated model that clinically identifies cycle of abuse. Healthy Parenting/Custody: All mothers who lost child custody during pregnancy were abusing substances and 50% who retained custody periodically abused substances; At one-year postpartum, 60% of mothers who continued substance abuse lived with their babies. Sobriety: 25% of mothers with drug abuse history remained sober throughout the study; 90% of babies had mothers who resumed substance abuse at 1-year postpartum and used at the New OB visit.

Clinical implications: The study identified opportunities for nursing intervention, and for EHR modification. Opportunities include a pediatric care management model initiated prior to delivery that incorporates additional Well Child Assessments with focus on the cycle of abuse. Suggested EHR modifications include a standardized EHR interactive template or flow sheet (of relative risk factors) that supports easy access by providers and nurses. The effect of government regulation on care and patient confidentiality/safety needs to be explored. This study has great potential to inform further evidence-based practice projects in nursing as well as within interdisciplinary health care and community programs.